房颤是一种常见的心律失常，随着人口老龄化，房颤的发病率呈逐年上升趋势。脑卒中是房颤主要并发症。日前发表在《柳叶刀 神经病学》的一篇论文数据显示，未接受抗凝治疗的房颤患者，每年脑卒中发病率达5%，而20%的脑卒中由房颤引起，因此抗凝治疗至关重要。房颤患者发生脑卒中的风险可通过CHADS2或CHA2DS2VASs得分来评估，经抗凝治疗后房颤患者发生脑卒中的机率降低了三分之二。

    抗凝药物维生素K拮抗剂，如华法林在临床上并未得到充分利用。新型口服抗凝剂如凝血酶抑制剂达比加群、Xa因子抑制剂利伐沙班和阿哌沙班，它们和华法林一样有效。研究显示，达比加群预防脑卒中的作用优于华法林，出血发生几率与之相当，颅内出血较华法林显著降低。利伐沙班至治疗效果也与华法林相当。不足之处是可能需要迅速有效的止血剂，必须精确监测血浆浓度以了解抗凝效应，胃肠道也有一定程度的出血风险，同时它们的价格比华法林贵。

    新型口服抗凝药可降低房颤患者的中风风险。临床上应重视非瓣膜性房颤患者的风险评分，积极进行抗凝治疗。

    Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation

    Prof Mark J Alberts MD, John W Eikelboom FRACP, Prof Graeme J Hankey MD

    Summary

    The world faces an epidemic of atrial fibrillation and atrial fibrillation-related stroke. An individual's risk of atrial fibrillation-related stroke can be estimated with the CHADS2 or CHA2DS2VASc scores, and reduced by two-thirds with effective anticoagulation. Vitamin K antagonists, such as warfarin, are underused and often poorly managed. The direct thrombin inhibitor dabigatran etexilate and factor Xa inhibitors rivaroxaban and apixaban are new oral anticoagulants that are at least as efficacious and safe as warfarin. Their advantages are predictable anticoagulant effects, low propensity for drug interactions, and lower rates of intracranial haemorrhage than with warfarin. A disadvantage is the continuing need to develop and validate rapidly effective antidotes for major bleeding and standardised tests that accurately measure plasma concentrations and anticoagulant effects, together with the disadvantage of possible higher rates of gastrointestinal haemorrhage and greater expense than with warfarin. The new oral anticoagulants should increase the number of patients with atrial fibrillation at risk of stroke who are optimally anticoagulated, and reduce the burden of atrial fibrillation-related stroke.